Usefulness of White Blood Cell Count and Serum Troponin-T Level in Predicting Survival After Acute Myocardial Infarction

Summary and ConclusionIn patients with acute coronary syndrome, management should be risk based from the time of arrival in the emergency room. Several tools have been used to risk stratify patients with this major event.White blood cell count is simple and universally available marker of inflammation. It is also a strong and independent predictor of mortality in the first year after acute myocardial infarction. Patients with high admission WBC count had larger infarcts size as assessed by higher peak CK levels and lower baseline ejection fraction.In addition to its diagnostic and prognostic significance at the early stages of acute coronary syndromes, troponin-T elevation in its second peak aids in risk stratification and may be predictive of infarct size and microinfarctions and it is more sensitive than CK-MB.Our study was conducted in 100 patients presented with first attack acute M.I., all received thrombolytic therapy and white blood cell count was done after 2 days of the onset of chest pain, another sample after one month and after 10 months. A blood sample for troponin-T level at the 4th day patients were followed up for one year as regard survival.We found that the high serum troponin-T on day 4 after A.M.I. is a powerful non-invasive predictor of mortality at one year follow up period. Also, we found that WBC count, which is a non-specific marker of inflammation, it appeared to be powerful, inexpensive, simple and non-invasive predictor of mortality.Recommendations:-1- Troponin T level at day 4 after AMI is essential to risk stratify all patients with this catastrophic event .2- WBC count at admission and after one month are only dependable as risk predictor but not after that.3- Neutrophil percentage is only dependable at admission as a risk predictor.4- WBC count could be used for further studies for targeting new therapies such as glycoprotein IIb / IIIa antagonists, low molecular weight heparin, or invasive versus conservative strategies.5- Further studies using coronary angiographic correlates with laboratory findings are advisable.References• Abe S, Arima S, Yamashita T, et al. (1994): Early assessment of reperfusion therapy using cardiac troponin-T. J Am Coll Cardiol 23:1382-90.• Adam D (2000): Acute coronary syndrome risk stratification. Heart 83:241-246.• Akira T, Toru W, Masaru N et al. (2001): Association between neutrophil counts on admission and left ventricular function in patients successfully treated with primary coronary angioplasty for first anterior wall acute myocardial infarction. Am J Cardiol 88:2086-2091.• American College of Physicians (1997): Guidelines for risk stratification after myocardial infarction. Ann